Proceedings of the Eighth International Conference on Probabilistic Safety Assessment & Management (PSAM)
197 How to Mediate between Health Information Security and Patient Safety (PSAM-0319)
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In order to ensure patient safety, rapid access to the necessary health information is crucial for healthcare personnel in many situations. The majority of the hospitalizations are unplanned, thus leaving little time for preparation of patient records. Even though electronic health records (EHR) are becoming more and more prevalent, the patient information is usually scattered over several clinical systems since the clinical information is local or specific to wards. A patient may easily have hundreds of separate, overlapping records in various systems. This limits the availability of the information.
A typical trend in order to solve this is by initializing integration efforts of the most central clinical systems, such as the laboratory systems, X-ray and EHR system. However, it is vitally important that the advantages of information integration do not sacrifice the patient privacy. Access control is therefore one of the key issues to be able to successfully merge and make efficient use of the large quantities of information. The flow of information between systems should not compromise the access control rules for the information in any of the systems, and this can be a challenge to achieve if not properly planned and implemented.
Most countries have strict legislation when it comes to sharing of sensitive healthcare information, and it is an ongoing discussion on how the privacy requirements sometimes actually compromises the patient safety by limiting the information to specific personnel on a need-to-know basis. Functionality for emergency or “blue light” access is implemented in most of the central clinical systems, but there are indications that this is being used on a too regular basis and therefore undermines patient privacy.
Hospitals are complex organization; something which is reflected in work flow and patient flow. This makes it difficult to create access control solutions, and will often result in either too wide general access control rights, or too extensive use of emergency access mechanisms. All this opens up possibilities for misuse. Discovering conflicts and grey areas is a first step towards understanding them and being able to mediate between the two important qualities patient safety and patient privacy. To avoid a belligerent conflict one needs a clear overview of both of these sides, which in turn makes it possible to let the safety and security aspects complement each other instead of being in opposition.
In many's opinion there are two opposing trenches, with aspects related to information security on one side and patient safety on the other. This paper focuses on how to detect conflicts and grey areas between patient safety and patient privacy, and shows some typical examples of such conflicts. It describes a set of applicable methods for analyzing planned or on-going healthcare integration efforts with a special focus on access control, and shows how these methods can be used to detect and mediate conflicts between health information security and patient privacy. The methods have been developed for and applied on some of the major hospitals in Norway.